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Change, reorganization and quality of home carefor elderly people in Sweden during the 1990s : paper to 17:e Nordiska konferensen i gerontologi 23-26 maj 2004 i Stockholm

Publiceringsår: 2004
Språk: Engelska
Publikation/Tidskrift/Serie: Working paper-serien
Volym: 2004
Nummer: 2
Dokumenttyp: Working paper
Förlag: Lunds universitet : Socialhögskolan


During the 1990s several kinds of reorganization has taken place in public services in Sweden.

Reorganizations according to the idea of market economy have been most salient and

debated. In many municipalities private companies have started to organize home care service

for elderly, financed by tax. Public home care organizations have reorganized the working

organization and managing structure, partly to save money and partly to reach better quality

of care. The home care services have a key role in the care of the elderly in the society. The

quality of care is important for the possibility for elderly to stay as long as possible in their

ordinary homes. We have performed a longitudinal study of the reorganizations during the

1990s in order to explore the consequences for quality of care.

The study was performed in seven districts in three different municipalities representing

different types of municipalities and different kinds of reorganizations. It comprises private

companies, traditional public organizations, public organizations with changed managing

structure and co-ordination of home help and home health care. Quality of care is studied

through assessment of the communication in the organization, the psychosocial working environment

of the caregivers and the quality of the care work. Politicians, managers, ca. 100 care

givers and ca. 500 elderly receiving help and care have been interviewed four times during the

period (1993, 1995, 1997 and 2002/2003).

The traditional organization within small districts with small autonomous working teams

and easy accessible supervisor expose the best quality. There are no unambiguous differences

between public and private organizations. There is however a tendency for successive decline

of quality for private companies after they have been established. Other aspects of the reorganizations,

e. g. to have special officials for assessment of help need, do not contribute to

better quality but create new communication gaps in the organization and have negative influence

on the working environment.

Stability in the composition of the care worker teams, leadership, decision-making processes

in the organization and the district area promote high quality of care. The reorganizations

during the 1990s seem on the whole to function contrary to promotion of high quality in

the care and service for the elderly.


  • Social Work


  • ISBN: 91-89604-27-X

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